<form name="registro" action="functions/registro.php" enctype="multipart/form-data">
    <fieldset>
        <legend>Datos de Acceso</legend>
        <label for="email">Email</label>
        <input type="text" name="email" size="20" maxlength="50" />
        <label for="pass">Contrase&ntilde;a</label>
        <input type="text" name="email" size="20"maxlength="50" />
        <label for="rpass">Repetir Contrase&ntilde;a</label>
        <input type="text" name="email" size="20" maxlength="50" />
    </fieldset>
    <fieldset>
        <legend>Datos de Perfil</legend>
        <label for="sexo">Sexo</label>
        <select name="sexo">
            <option value="mas">Masculino</option>
            <option value="fem">Femenino</option>
        </select>
        <label for="fechanacimiento">Fecha de Nacimiento</label>
        <select name="dia">
            <option value="1">1</option>
            <option value="2">2</option>
            <option value="3">3</option>
            <option value="4">4</option>
            <option value="5">5</option>
            <option value="6">6</option>
            <option value="7">7</option>
            <option value="8">8</option>
            <option value="9">9</option>
            <option value="10">10</option>
            <option value="11">11</option>
            <option value="12">12</option>
            <option value="13">13</option>
            <option value="14">14</option>
            <option value="15">15</option>
            <option value="16">16</option>
            <option value="17">17</option>
            <option value="18">18</option>
            <option value="19">19</option>
            <option value="20">20</option>
            <option value="21">21</option>
            <option value="22">22</option>
            <option value="23">23</option>
            <option value="24">24</option>
            <option value="25">25</option>
            <option value="26">26</option>
            <option value="27">27</option>
            <option value="28">28</option>
            <option value="29">29</option>
            <option value="30">30</option>
            <option value="31">31</option>
        </select>
        <select name="mes">
            <option value="1">Enero</option>
            <option value="2">Febrero</option>
            <option value="3">Marzo</option>
            <option value="4">Abril</option>
            <option value="5">Mayo</option>
            <option value="6">Junio</option>
            <option value="7">Julio</option>
            <option value="8">Agosto</option>
            <option value="9">Septiembre</option>
            <option value="10">Octubre</option>
            <option value="11">Noviembre</option>
            <option value="12">Diciembre</option>
        </select>
        <input type="text" size="4" maxlenght="4"><small class="ayuda">(Ej: 1998)</small>
        <label for="estado">Estado Civil</label>
        <select name="estado">
            <option value="sol">Soltero/a</option>
            <option value="alg">Con Alguien</option>
            <option value="cas">Casado/a</option>
            <option value="sep">Separado/a</option>
        </select>
        <label for="intereses">Intereses</label> <small class="ayuda">200 Caracteres</small>
        <label for="imagen">Imagen de Perfil</label>
        <input type="file" name="imagen">
        <textarea cols="60" rows="6" name="intereses"></textarea>
    </fieldset>
</form>